- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $3,801.89 / $3,801.89
| Facility | | $3,801.89 | $3,801.89 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,630.78 / $4,168.69 / $6,606.93
| Professional | | $3,630.78 | $4,168.69 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $6,025.60 / $33,884.42
| Facility | | $2,754.23 | $6,025.60 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,309.57 / $9,549.93 / $15,135.61
| Professional | | $6,309.57 | $9,549.93 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,000.00 / $14,125.38 / $33,884.42
| Facility | | $10,000.00 | $14,125.38 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,943.28 / $12,022.64 / $18,197.01
| Professional | | $7,943.28 | $12,022.64 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,715.19 / $13,489.63 / $26,302.68
| Facility | | $10,715.19 | $13,489.63 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,244.36 / $10,232.93 / $15,135.61
| Professional | | $7,244.36 | $10,232.93 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $5,495.41 / $8,709.64
| Facility | | $3,388.44 | $5,495.41 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,677.35 / $8,511.38 / $22,908.68
| Professional | | $4,677.35 | $8,511.38 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,467.37 / $8,511.38
| Facility | | $1,584.89 | $3,467.37 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,365.16 / $8,128.31 / $16,218.10
| Professional | | $4,365.16 | $8,128.31 | $16,218.10 |